Landscapes of practice in medical education.

Sociocultural learning theories play an important part in medical education. When Etienne Wenger-Trayner described 'communities of practice' oriented around three common features (mutual engagement, joint enterprise, shared repertoire), his approach was enthusiastically embraced across a range of fields, including those of clinical medicine and medical education. However, this model is limited by its focus on a single community. Recently, leading sociocultural learning theorists including Wenger-Trayner have proposed the landscape of practice as a model for how learner identities develop, but this theory has not yet been utilised in medical education. In this Cross-cutting Edge paper, I describe the key features of landscapes of practice. The landscape of practice encompasses all the communities of practice, and learners can move between these. The boundaries between communities of practice are particularly fertile settings for learning, either through occasional forays across borders or through complete multimembership of two or more communities of practice. The capacity to navigate knowledge acquisition and identity formation across the landscape, known as 'knowledgeability,' therefore becomes crucial. This paper concludes by describing possible applications of the landscapes of practice model in medical education practice and research. The model provides a rich framework for approaching cross-discipline learning, although it has been criticised for failing to address the difficulties created by wide disparities in power within communities and for an unrealistically collaborative (rather than competitive) view of boundary relations. Nevertheless, it provides a novel way of understanding the identity formation of medical trainees and students.